13例腹腔镜胆囊切除术中意外胆囊癌的临床处理

Clinical management of 13 cases on unexpected gallbladder cancer discovered during laparoscopy

目的回顾性评价腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中意外胆囊癌的诊断、处理及预后。方法对本院1998年1月至2008年12月7861例LC中13例意外胆囊癌（unexpected gallbladder cancer，UGC）的临床资料进行回顾性分析。结果术中发现7例和术后发现6例中的5例行胆囊癌根治术，而仅行LC8例。术后病理TNM分期：工期8例，Ⅱ期4例，Ⅲ期1例。13例术后随访6～60个月，平均25．1个月，死亡9例，其中接受胆囊癌根治手术的5例术后1、3、5年的生存率分别为80％（4／5）、40％（2／5）、20％（I／5）；而仅行LC的8例术后1年生存率为50％（4／8），无生存超过2年者。结论LC术中应高度警惕意外胆囊癌的发生，意外发现的胆囊癌多为早期，对早期胆囊癌应行标准胆囊癌根治术，仅行单纯的LC治疗效果欠佳。

Objective To retrospectively assess the diagnosis, treatment and prognosis for unexpected gallbladder carcinomas （UGC）discovered during laparoscopic cholecystectomy（LC）. Methods From January 1998 to December 2008,7861 cases of LC were performed in our hospital,UGC was discovered in 13 of the cases. Clinical data of the 13 patients were analyzed retrospective- ly. Results Among the 13 cases of UGC,7 were discovered intraoperatively,and 6 were diagnosed postoperatively. Radical chole- cystectomy was performed on the 7 cases who were detected during the operation,and 5 of the 6 patients who were diagnosed after the operation. LC was earried out in the remaining 8 eases. Postoperative pathological examination showed TNM stage I in 8 cases, stageⅡ in 4,and stage Ⅲ in 1. The patients were followed up for 6--60 months with a mean of 25.1 months. During the period,9 patients died. The 1,3, and 5 years survival rate of the 5 patients who received radical choleeystectomy were 80% （4/5）, 40 % （2/5）, and 20% （1/5）,respeetively Whereas,in the 8 patients who underwent LC, the 1 year survival rate was 50 %; moreover, none of the 8 survived for more than 2 years. Conclusion In the LC,should be care of unexpeeted gallbladder cancer that almost in early, and the treatment is in effective.